From the Guidelines
Magnesium succinate is contraindicated in acute kidney injury (AKI) due to the risk of hypermagnesemia, which can occur when the kidneys are unable to effectively eliminate excess magnesium from the body. The kidneys play a crucial role in regulating magnesium levels through renal excretion 1. In AKI, compromised renal function leads to reduced magnesium excretion, increasing the risk of magnesium accumulation to toxic levels. This can result in serious complications, including:
- Hypotension
- Respiratory depression
- Cardiac arrhythmias
- Neuromuscular blockade
- Cardiac arrest in severe cases
The primary concern in AKI is the magnesium component, rather than the succinate component, as magnesium is the primary issue in renal impairment 1. Patients with AKI typically require careful monitoring of magnesium levels if they are receiving any magnesium-containing supplements or medications. Dosage adjustments or complete avoidance may be necessary depending on the severity of kidney dysfunction, particularly in individuals with a creatinine clearance of <20 mg/dL 1. Alternative treatments that don't contain magnesium should be considered for patients with AKI requiring supplementation for other conditions.
From the FDA Drug Label
Warnings Ask a doctor before use if you have kidney disease The FDA drug label does not answer the question.
From the Research
Magnesium Succinate Contraindication in AKI
- Magnesium succinate is contraindicated in acute kidney injury (AKI) due to the potential for magnesium accumulation and toxicity 2, 3, 4, 5.
- Studies have shown that hypermagnesemia is associated with increased mortality risk and adverse outcomes in AKI patients 2, 5.
- The use of magnesium-containing products, such as magnesium succinate, may exacerbate hypermagnesemia and worsen outcomes in AKI patients 3, 4.
- In patients with AKI, it is essential to monitor serum magnesium levels closely and avoid using magnesium-containing products unless absolutely necessary 3, 5.
Mechanism of Magnesium Toxicity in AKI
- Magnesium toxicity can occur in AKI patients due to the reduced ability of the kidneys to excrete excess magnesium 3, 4.
- Hyperphosphatemia, a common complication of AKI, can also contribute to magnesium toxicity by forming insoluble complexes with magnesium 4.
- The use of continuous kidney replacement therapy (CKRT) may also increase the risk of magnesium toxicity in AKI patients 3, 5.
Clinical Implications
- Clinicians should exercise caution when using magnesium-containing products in patients with AKI or those at risk of developing AKI 2, 3, 4, 5.
- Close monitoring of serum magnesium levels is essential in AKI patients to prevent magnesium toxicity and optimize outcomes 3, 5.
- Alternative treatments that do not contain magnesium should be considered in patients with AKI or those at risk of developing AKI 6.